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. 2016 Jun 30;11(6):e0157470.
doi: 10.1371/journal.pone.0157470. eCollection 2016.

Systematic Review of Willingness to Pay for Health Insurance in Low and Middle Income Countries

Shirin Nosratnejad  1   2 , Arash Rashidian  3   4 , David Mark Dror  5   6
Affiliations

Systematic Review of Willingness to Pay for Health Insurance in Low and Middle Income Countries

Shirin Nosratnejad et al. PLoS One. .

Abstract

Objective: Access to healthcare is mostly contingent on out-of-pocket spending (OOPS) by health seekers, particularly in low- and middle-income countries (LMICs). This would require many LMICs to raise enough funds to achieve universal health insurance coverage. But, are individuals or households willing to pay for health insurance, and how much? What factors positively affect WTP for health insurance? We wanted to examine the evidence for this, through a review of the literature.

Methods: We systematically searched databases up to February 2016 and included studies of individual or household WTP for health insurance. Two authors appraised the identified studies. We estimated the WTP as a percentage of GDP per capita, and adjusted net national income per capita of each country. We used meta-analysis to calculate WTP means and confidence intervals, and vote-counting to identify the variables that more often affected WTP.

Result: 16 studies (21 articles) from ten countries met the inclusion criteria. The mean WTP of individuals was 1.18% of GDP per capita and 1.39% of adjusted net national income per capita. The corresponding figures for households were 1.82% and 2.16%, respectively. Increases in family size, education level and income were consistently correlated with higher WTP for insurance, and increases in age were correlated with reduced WTP.

Conclusions: The WTP for healthcare insurance among rural households in LMICs was just below 2% of the GPD per capita. The findings demonstrate that in moving towards universal health coverage in LMICs, governments should not rely on households' premiums as a major financing source and should increase their fiscal capacity for an equitable health care system using other sources.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Article flowchart for studies of WTP for insurance demonstrating the studies identified assessed and included in the systematic review.
Fig 2
Fig 2
The reported Willingness to pay for health insurance in different studies, and the overall estimated WTP of individual as a % of GDP (a), and as a % of net national income (b), WTP for household as a % of GDP (c) and as a % of net national income (d).
See this image and copyright information in PMC

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